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Suicide rates among pharmacists are higher than those in the general population, according to a longitudinal analysis.

Using data from the CDC's National Violent Death Reporting System (NVDRS) for the years 2003 to 2018, 316 pharmacist suicides were identified compared with 213,146 nonpharmacist suicides, reported Kelly Lee, PharmD, of the Skaggs School of Pharmacy and Pharmaceutical Sciences at the University of California San Diego, and colleagues.

Age-adjusted rates for pharmacist suicides were 19.6, 20.1, and 18.2 per 100,000 in 2004, 2009, and 2014, respectively, they noted in the . By comparison, the 2017 age-adjusted suicide rate in the general public was 14 per 100,000 individuals, the authors noted.

"There really hasn't been any data that's been published regarding pharmacist suicides in the U.S." until now, Lee told MedPage Today.

"We know that burnout is a result of caregiver burden," she said. Nurses, doctors, and pharmacists give a piece of themselves when they're caring for patients, and "I think that we don't realize the toll that it takes to provide that care every day."

Stigma often discourages pharmacists and other healthcare professionals from reporting mental health challenges.

"There's ... huge implications for a healthcare professional to admit that they have mental health, substance use disorder [challenges] ... because we're not supposed to have that. I mean, the public doesn't want to hear that their doctor is contemplating suicide. The public does not want to hear that the person dispensing their medication has depression. ... But we're not immune to mental health disorders," Lee noted.

Of the 316 pharmacists who died by suicide, firearms were the most common method, accounting for 134 deaths, followed by poisoning, which was used in 79 deaths, and hanging, strangling, or suffocation, which was the method used in 35 deaths.

Firearm use was similar among pharmacists and nonpharmacists, but poisoning was a more common method among pharmacists (29.4% vs 16.7%, respectively, P<0.0001), while hanging, strangulation, and suffocation were more frequently used by nonpharmacists (13.0% vs 24.5%, respectively, P=0.007).

Lee said that she and her colleagues were surprised to find that firearms were the most common method of suicide over poisoning, given pharmacists' access to medications, but noted that medications often do not necessarily "guarantee a death."

Compared with nonpharmacists, suicide among pharmacists was more commonly associated with job problems (OR 1.77, 95% CI 1.32-2.37, P=0.011) and current treatment for mental illness (OR 1.56, 95% CI 1.24-1.96, P=0.008).

Of the 316 pharmacists, mean age was 53.5, 75% were men, and 85% were white.

Men in this group were significantly less likely than women to have attempted suicide in the past (OR 0.34, 95% CI 0.18-0.62, P=0.018), and less likely to have a "recorded mental health problem," current or past history of treatment for mental illness, or a history of suicidal thoughts. However, they were more likely to have a physical health problem associated with the suicide (OR 2.81, 95% CI 1.28-6.19, P=0.238).

In an , Delesha Carpenter, PhD, MSPH, of the University of North Carolina at Chapel Hill, called attention to the fact that job problems and current treatment for mental health were both associated with pharmacist suicide. "Given the recent attention that pharmacist job stress and burnout has received in the literature, these findings are particularly concerning," she wrote.

Carpenter recommended formally training "suicide prevention gatekeepers," individuals who can identify at-risk persons, validate their feelings, and expedite referrals. Institutions and workplaces can require suicide prevention trainings or Mental Health First Aid training, she suggested, and professional societies can promote such offerings.

Furthermore, professional societies should work together "to collectively lobby for improved suicide prevention resources at the local, state, and national level," Carpenter wrote.

Lee too said that more widespread preventive measures need to be put in place in work settings and also argued that institutions and workplaces should "promote well-being" through policies such as limiting e-mail sends to work hours, providing protected time for lunch, and providing adequate spacing between exams for students.

She and her co-authors are currently researching what nursing boards, medical licensing boards, and pharmacy boards are doing to help those who are dealing with mental and behavioral health challenges.

Currently among pharmacy boards, "there is no room for mistakes ... and that's unfortunate," Lee added. "We are punishing or penalizing people for having a disorder."

The NVDRS is a surveillance system from the CDC that pools suicide data collected from death certificates, medical examiner and law enforcement reports, and toxicology results into an anonymous database by state.

In all, 13 states reported to the NVDRS in 2004, 16 in 2009, and 18 in 2014. In total, the 2003-2018 dataset included suicides reported in 39 states, Washington, D.C., and Puerto Rico.

One significant limitation to the study was the small sample size. Furthermore, Lee and colleagues were only able to calculate age-adjusted rates in certain years.

If you or anyone you know is struggling with a mental health concern or having thoughts of suicide, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).

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